Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China.
Central Research Laboratory, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, China.
BMC Pregnancy Childbirth. 2019 Jul 29;19(1):269. doi: 10.1186/s12884-019-2417-1.
The occurrence of thrombocytopenia is as high as 7-12% in pregnancy, yet minimum platelet count safe for cesarean section remains unknown.
In this retrospective noninferior cohort study, we consecutively included patients undergoing cesarean section for a period of 6 years in a tertiary hospital and excluded patients at very high risk for excessive hemorrhage. The included patients with preoperative platelet count of 50-100 × 10/L were defined as the thrombocytopenic group. The control group were eligible patients with preoperative platelet count>150 × 10/L, matched to the thrombocytopenic group by age and operation timing in a 1:2 ratio. Mixed effect model was used to analyze the effect of thrombocytopenia based on a noninferiority assumption. The predefined noninferiority delta of bleeding was 50 mL.
There was no significant difference of the calculated blood loss between the thrombocytopenic and the control group (mean difference = 8.94, 95% CI - 28.34 mL to 46.09 mL). No statistical difference was observed in the requirement for blood transfusion, visually estimated blood loss, or the incidence of adverse events between groups. Although there were more patients admitted to intensive care unit (odds ratio = 12, 95% CI 2.69-53.62, p = 0.001) in the thrombocytopenic group, most of them required critical care for reasons other than hemorrhage. The thrombocytopenic group had longer length of hospital stay (mean difference = 0.40 days, 95% CI 0.09-0.71, p = 0.011), but the difference was considered as clinically insignificant.
Preoperative moderate thrombocytopenia is not associated with increased blood loss, blood transfusion, or occurrence of adverse events in patients undergoing cesarean section in absence of additional bleeding risk.
妊娠时血小板减少的发生率高达 7-12%，但剖宫产术时血小板安全下限仍不清楚。
本回顾性非劣效队列研究连续纳入了一家三级医院 6 年间行剖宫产术的患者，并排除了有大出血极高风险的患者。术前血小板计数为 50-100×10/L 的患者被定义为血小板减少组。对照组为术前血小板计数>150×10/L、与血小板减少组按年龄和手术时间 1:2 匹配的合格患者。采用混合效应模型分析基于非劣效假设的血小板减少的影响。出血的预设非劣效差值为 50mL。
血小板减少组与对照组的计算出血量无显著差异（平均差值=8.94，95%CI-28.34mL 至 46.09mL）。两组间输血需求、目测失血量或不良事件发生率均无统计学差异。尽管血小板减少组有更多的患者入住重症监护病房（比值比=12，95%CI 2.69-53.62，p=0.001），但他们大多数因非出血原因需要重症监护。血小板减少组的住院时间更长（平均差值=0.40 天，95%CI 0.09-0.71，p=0.011），但差异被认为临床无意义。
在无额外出血风险的情况下，剖宫产术前血小板中度减少与术中出血量增加、输血需求增加或不良事件发生无关。
